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Specialty Medication Prior Authorizations

As of January 1, 2023, National CooperativeRx has taken over specialty medication prior authorizations for our member groups’ plan participants. Similar to our innovative clinical programs, this service is provided at no cost to our members.

Controlling Specialty Costs

We have identified an opportunity to save members millions of dollars in specialty medication costs – by managing specialty medication prior authorization functions within our Cooperative.

Now, over one year into the program, we are able to demonstrate significant savings, an elevated level of clinical quality, and enhanced customer service. We estimate, based on historical trends and market comparisons, that National CooperativeRx membership saved between $19.3 million and $24.9 million in drug costs for 2023 as a result of the specialty medication prior authorization program.

Read our blog to learn more about the first-year results of our specialty medication prior authorization program.

Business person reviewing prior authorizations
Person reviewing costs of specialty drugs

In 2023, specialty medications among National CooperativeRx membership accounted for 1.5% of claims, yet 47% of total pharmacy spend.

Specialty medications are prescriptions used to treat specific chronic and/or genetic conditions. Specialty medications are costly to pharmacy benefit plans due to the special handling required.

a group of people reviewing information on laptop

Prior authorizations entail the reviewing of medications or procedures to ensure clinical appropriateness. Prior authorizations may be required by pharmacy benefit plans before providing coverage.

More Information

Contact Specialty Prior Authorization Department

1-877-205-6592 toll-free



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